The Top 5 Errors Chiropractors Make in Medicare

Though many chiropractors love to hate Medicare because it wields a big stick and seems to cause big problems, one bit of saving grace about the CMS giant is that continually try to inform the chiropractic profession on what we are doing wrong.

Call it a being a little lazy (or working smarter), but rather than dive down the deep hole of incessantly trying to improve our documentation, today’s post is about analyzing the problems with your Medicare patient notes in reverse.

In other words, if we look at what Medicare actually says we are doing wrong, then we have an immediate agenda of what we should start to fix. Thankfully, we don’t have to guess this.

Throughout the year, Medicare conducts a random review process (known as CERT or Comprehensive Error Rate Testing) and here is what they said chiropractors are doing incorrectly as a result of those reviews:

Chiropractic CERT Errors According to Medicare

CERT errors have been found specific to services incorrectly coded, medical necessity and insufficient documentation. Chiropractic manipulative treatment codes, such as 98940, 98941 and 98942, were not supported due to:

No chiropractic treatment plan documented to support a plan of care

Documentation does not support the performance of chiropractic manipulative therapy on the billed date of service

The chiropractic medical records are illegible or abbreviations used cannot be determined

Though a validICD-9/ICD-10 code(s) was submitted, the ICD-9/ICD-10 code(s) alone was insufficient information

Records for the wrong dates of service were submitted

Where We All Go Wrong

Here’s the interesting part. The above are the results of a CERT review conducted by Noridian Medicare (the carrier for much of the Western United States) in January 2017. But my research ninjas helped me dig up the dirt from chiropractors providing services for other carriers around the country – and the results were nearly identical.

In fact, the primary difference between carriers was not what we were submitting incorrectly, it was the percentage of chiropractors who FAILED to respond to the CERT request for documentation and submit anything at all. In some cases, nearly 35% of the chiropractors fell into this category!

What to Do Next

If you’re looking to improve your Medicare documentation, decrease the chances of a post-payment audit payback, then the place to start is with the above list.

Start today! Take a look at a few of your notes for your Medicare patients. Would they fall short on the items above or do you typically do all that’s required?

And when you are on the receiving end of a CERT audit, submit the requested documentation! Even if your notes are substandard according to Medicare, at least you will know what they think is wrong and have an opportunity to fix it.